The Geriatric Dental Program Project (GDPP) will bring a multidiscipline approach to define the dental and the oral-pharyngeal health status of a large number of elderly individuals and will seek to identify those parameters both clinical and bacteriological that may predispose the individual to a disease outcome such as dental decay, periodontal disease, swallowing disorders and possibly aspiration pneumonia. The basic approach will be an in depth dental and oropharyngeal clinical examination on an annual basis that will include measurements of mutants streptococci, lactobacilli and aerobic gram negative bacilli (GNB) in the saliva, measurements of salivary protease activity and the quantification of antimicrobial proteins such as lactoferrin, lysozyme and IgA in the saliva. We will determine the incidence of xerostomia and swallowing complaints in this population and relate them to the salivary levels of the aciduric flora, the proteolytic flora and aerobic GNB. We will also study elderly patients who have swallowing problems, or dysphagia, due to known medical conditions. We will evaluate and compare non-xerostomic dysphagic patients and those with xerostomia secondary to drugs or absence of oral intake (NPO) along several measures relating to swallowing and aspiration. By using a sample of geriatrics individuals with normal swallowing patterns as controls, and dysphagic patients we will perform a more in-depth bacteriological analysis of the oral flora and will evaluate the relationship between fibronectin coating of the buccal epithelial cells and the ability of normally foreign bacteria, such as the GNB, to adhere to these cell surfaces. We will determine whether the GNB are derived from endogenous sources by gastric refluxing, in which case there may be coinfections with intestinal anaerobes. As GNB in the oropharyngeal secretions are considered as one of the risk factors for aspiration pneumonia these studies could have important implications for the health of the individual. Finally, by tracking these patients and normals we will identify who contracts aspiration pneumonia and determine whether any of the monitored bacteriological and salivary factors can be identified as oral risk factors for aspiration pneumonia. The GDPP is organized into four research groups representing the disciplines of gerontology, medicine, dentistry, bacteriology, immunology and speech pathology and a biostatistical supporte core that will examine in detail various parameters affecting the salivary and oropharyngeal flora in health and in disease situations.